| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22,712 |
5,653 |
$2.60M |
| 41899 |
Unlisted procedure, dentoalveolar structures |
6,570 |
6,531 |
$1.93M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14,284 |
4,156 |
$1.39M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,666 |
8,508 |
$1.26M |
| D9420 |
|
16,904 |
12,295 |
$1.24M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,510 |
14,425 |
$861K |
| D2330 |
|
9,902 |
4,169 |
$748K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,140 |
2,148 |
$590K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,856 |
3,582 |
$576K |
| D1120 |
Prophylaxis - child |
18,797 |
18,668 |
$463K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,410 |
4,747 |
$413K |
| D0120 |
Periodic oral evaluation - established patient |
8,871 |
8,849 |
$408K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,168 |
4,781 |
$379K |
| D7240 |
Removal of impacted tooth - completely bony |
1,570 |
744 |
$350K |
| D0210 |
Intraoral - complete series of radiographic images |
6,869 |
6,856 |
$317K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,537 |
956 |
$284K |
| D0330 |
Panoramic radiographic image |
8,182 |
8,115 |
$226K |
| D1110 |
Prophylaxis - adult |
2,622 |
2,619 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,283 |
19,508 |
$194K |
| D7230 |
|
951 |
441 |
$176K |
| D9220 |
|
857 |
855 |
$168K |
| D1351 |
Sealant - per tooth |
5,973 |
2,185 |
$157K |
| D1206 |
Topical application of fluoride varnish |
16,156 |
16,067 |
$156K |
| D0272 |
Bitewings - two radiographic images |
13,145 |
13,055 |
$149K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,707 |
1,521 |
$132K |
| D2160 |
|
1,681 |
860 |
$131K |
| D9430 |
|
3,933 |
3,794 |
$123K |
| D2331 |
|
1,615 |
1,032 |
$122K |
| D9222 |
|
978 |
973 |
$116K |
| D0350 |
|
9,971 |
4,550 |
$107K |
| D1510 |
|
668 |
442 |
$101K |
| D9221 |
|
1,117 |
783 |
$96K |
| 99221 |
|
386 |
386 |
$75K |
| D2140 |
|
1,432 |
718 |
$75K |
| D0274 |
Bitewings - four radiographic images |
4,079 |
4,067 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,824 |
1,579 |
$69K |
| D4910 |
|
1,099 |
1,091 |
$68K |
| 99218 |
|
249 |
248 |
$63K |
| 0360 |
|
722 |
272 |
$62K |
| D2933 |
|
478 |
142 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,962 |
3,880 |
$45K |
| D2332 |
|
391 |
302 |
$31K |
| D0160 |
|
167 |
167 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,316 |
1,303 |
$13K |
| D2335 |
|
94 |
74 |
$11K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
102 |
102 |
$10K |
| D0270 |
|
1,909 |
1,872 |
$9K |
| D3230 |
|
38 |
13 |
$4K |
| 0710 |
|
244 |
177 |
$3K |
| D2394 |
|
32 |
27 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
42 |
42 |
$1K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
140 |
140 |
$1K |
| D9610 |
|
19 |
18 |
$1K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
124 |
124 |
$853.84 |
| D3221 |
|
14 |
13 |
$819.00 |
| D0322 |
|
12 |
12 |
$800.00 |
| D1310 |
|
167 |
166 |
$736.00 |
| D0340 |
|
14 |
14 |
$700.00 |
| 99217 |
|
13 |
13 |
$149.40 |
| D0140 |
Limited oral evaluation - problem focused |
2,617 |
2,557 |
$0.00 |
| D1330 |
|
283 |
281 |
$0.00 |
| D0603 |
|
94 |
94 |
$0.00 |
| D2752 |
|
16 |
12 |
$0.00 |
| D0366 |
|
19 |
19 |
$0.00 |
| D2950 |
|
106 |
92 |
$0.00 |
| D4341 |
|
37 |
25 |
$0.00 |
| D9993 |
|
12 |
12 |
$0.00 |